TPF induction (docetaxel/cisplatin/5-FU) fails to beat PF adjuvant after CCRT in LA-NPC

TPF is a 3-drug cytotoxic induction regimen (taxane + platinum + fluoropyrimidine) given pre-radiation to debulk disease and reduce distant relapse risk; here it was tested as 3 cycles of TPF induction → IMRT + concurrent cisplatin (IC+CCRT) versus IMRT + concurrent cisplatin → PF adjuvant (CCRT+AC) in a multicenter Phase III trial in newly diagnosed stage III–IVA nasopharyngeal carcinoma (n=266; 133/arm; median follow-up 58 months; NCT03574324). Five-year outcomes were statistically similar: PFS 66.6% vs 66.0% in ITT (RR 0.89; p=0.589) and 75.3% vs 69.9% per-protocol (RR 0.85; p=0.471), with OS 73.0% vs 71.3% (RR 0.88; p=0.582), LRFS 87.4% vs 90.8% (RR 1.30; p=0.508), and DMFS 76.9% vs 72.6% (RR 0.75; p=0.267). Toxicity was reported as similar long-term between arms; relative to a common benchmark of IMRT + concurrent cisplatin alone (historically ~5-year OS in the high-70% range in stage III–IV disease), these survival rates look broadly “in-family,” but this study specifically argues that swapping PF-adjuvant for TPF-induction does not move the needle.